Yes, gout, exactly. Has there been any redness or peely skin? Gout is horrendously underdiagnosed in the community, particularly in males who happen to drink alcohol sometimes, and it's relatively more common in people who have increased cell turnover for any reason (I don't know if PJS hamartomas cause increased intestinal cell turnover, but it sounds plausible to me). And even if there's a really small chance you have it, it's important to diagnose early because it's very easy to treat by dietary modification. Much easier to prevent buildup of crystal in hitherto unaffected joints than to try and get rid of crystals that have accumulated unnoticed.
MC+S means send to microbiology for microscopy, culture and sensitivity. This is routine in hospitals although a bit more of a hassle for GPs (but not if you offer to drive home via the local hospital path lab and drop the sample off yourself). Might not be absolutely necessary if fluid appears beautifully pristine, but one wouldn't want to miss an infection if one is going to inject steroids.
How easy it is to get polarised light microscopy depends very much on your local lab. In our hospital, they quite enjoy doing it, but they never seem to see anything. Which is why a normal urate would also be reassuring in effectively ruling out gout.
Fortunately for you, it's less useful to measure blood urate during the attack (nobody knows why this is, but it's true - elevated levels can dip during a flare of gout) - it's best to measure it later, once the inflammation has settled down.
I don't see why you can't ask for all that, especially if you say that you wondered if there could be any association between PJS and gout, because you've heard that gout quite commonly appears as an olecranon bursitis. Most GPs, if faced with a talkative patient requesting a fairly cheap test on a sample they're going to take anyway, take the path of least resistance and simply agree. It takes 5 mins or so for the local anaesthetic to start working, so there will be time to chat!
Like the jolly GP who sent my blood for TFTs and ferritin recently (not knowing that I am medically trained) on the basis that I'd been "feeling a bit tired and cold and my mum said I ought to get it done". You just have to ask in a "I was really worrying about this and just wondered if you could set my mind at rest" kind of way, not a "look, as a taxpayer I pay your wages" kind of way.
If you went private, they would definitely do it if you asked, partly because it's all billable to the insurance company.
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Date: 2007-04-20 06:08 pm (UTC)MC+S means send to microbiology for microscopy, culture and sensitivity. This is routine in hospitals although a bit more of a hassle for GPs (but not if you offer to drive home via the local hospital path lab and drop the sample off yourself). Might not be absolutely necessary if fluid appears beautifully pristine, but one wouldn't want to miss an infection if one is going to inject steroids.
How easy it is to get polarised light microscopy depends very much on your local lab. In our hospital, they quite enjoy doing it, but they never seem to see anything. Which is why a normal urate would also be reassuring in effectively ruling out gout.
Fortunately for you, it's less useful to measure blood urate during the attack (nobody knows why this is, but it's true - elevated levels can dip during a flare of gout) - it's best to measure it later, once the inflammation has settled down.
I don't see why you can't ask for all that, especially if you say that you wondered if there could be any association between PJS and gout, because you've heard that gout quite commonly appears as an olecranon bursitis. Most GPs, if faced with a talkative patient requesting a fairly cheap test on a sample they're going to take anyway, take the path of least resistance and simply agree. It takes 5 mins or so for the local anaesthetic to start working, so there will be time to chat!
Like the jolly GP who sent my blood for TFTs and ferritin recently (not knowing that I am medically trained) on the basis that I'd been "feeling a bit tired and cold and my mum said I ought to get it done". You just have to ask in a "I was really worrying about this and just wondered if you could set my mind at rest" kind of way, not a "look, as a taxpayer I pay your wages" kind of way.
If you went private, they would definitely do it if you asked, partly because it's all billable to the insurance company.